Chicago Podiatric Surgeons


	Patient Survey

			Please take a moment to answer the following questions as best as you can. This information is being gathered to help improve patient satisfaction and to aid in the development of additional patient care programs. We value your time, opinions, and privacy. All answers will be kept confidential. All questions are optional, please answer as many as possible. Thank you!



	How would you rate the overall quality of care you received? Excellent Good Fair Poor Undecided

	How did you make an appointment? called the office online If online, did you receive a call from our staff to confirm your appointment within: 24 business hours 48 business hours more than 48 business hours If you spoke to our staff member regarding your appointment, was the staff member friendly and helpful? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree Was there an appointment time that suited your need? yes no If no, please explain: Were you able to find parking in the area? yes no I didn't need parking Upon check in did the front office personnel greet you with a friendly and helpful manner? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree Was the medical support personnel (nurses, assistants) friendly and helpful during your visit? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree Were you satisfied with the care you received from your doctor? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree Upon checking out were you treated in a friendly and helpful manner by the front office staff? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree Did the billing department respond to your questions in a satisfactory manner? Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongly Disagree When would you prefer to see the doctor? Please check all that apply. 7-9 AM 9 AM - 12 PM 12-5 PM Saturdays

	What is your age? under 18 18-25 26-34 35-49 50-64 65 or older

	Any other comments that you would like to share with us: